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Simple Changes for Boosting ER Throughput

By jfellows@healthleadersmedia.com  
   September 18, 2015

"Some of it might look like window dressing, but it just was directed at the senior's needs," says Eig.

And the cost to make those changes? Low—only $150,000.

"It was simple things that didn't cost a lot of money," says Eig. "We, in hospitals, had tended to do things that are good for the hospitals. To provide the best care, we started thinking what is best for our patients who use the hospital."

The volume of seniors treated at the Holy Cross Senior Emergency Center has grown steadily to an average of 3,358 patients, a 5% increase over its first-year numbers. About 24% of the seniors who come through the Holy Cross Hospital ED end up using the hospital's SEC.

The criteria for being seen in the SEC are that patients must be over 65 years old and stable. Acute senior patients still have to be seen in the regular ED, but Eig says that all of the staff at Holy Cross has received specialized senior-care training through workshops that aim to help providers understand seniors' needs.

"As our patient population becomes older, those patients become more and more complex," says Sue Penoza, BSN, MA, RN-BC, director of growth and strategic leadership at Trinity Health. "That doesn't necessarily fit with EDs that were developed in the 1950s, '60s, and '70s, when the population was younger. For example, we want rapid diagnosis, treatment, and disposition in EDs, but that doesn't necessarily fit with our older population's greater needs, which may have multiple medications, changes in their mental status, and multiple chronic diseases."

Penoza also says that Trinity Health recognized the need for more senior emergency rooms and recommended in 2010 that all Trinity Health hospital partners implement an SEC like the one at Holy Cross. According to Trinity Health's data, its seniors comprise a larger percentage than is present in the general population.

"According to the U.S. Census Bureau, 13% of the population is age 65 or older," says Penoza. "In Trinity Health legacy hospitals, 19% of ER visits are 65 and older … 50% of patients admitted to the hospital through the ER are age 65 or older."

The idea of having senior emergency rooms at every Trinity Health hospital was short-lived. Penoza says it became clear quickly that other ED initiatives needed to move forward first. So instead of a directive to hospitals, it became a suggestion, one that 13 hospitals, to date, took to heart, including Saint Alphonsus Health System, a four-hospital system with facilities in Idaho and Oregon.

It's one of the newest hospital systems to answer Trinity Health's call for setting up a senior emergency room.

Jacqueline Fellows is a contributing writer at HealthLeaders Media.

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